Mineralocorticoid Receptor Antagonist Prescribing for HFpEF at Hospital Discharge Remains Low

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The prescribing of mineralocorticoid receptor antagonist at hospital discharge was found to be low in patients heart failure with preserved ejection fraction.

The prescribing of mineralocorticoid receptor antagonist (MRAs) was found to be low in patients heart failure (HF) with preserved ejection fraction (HFpEF) at hospital discharge, according to a study published in the American Journal of Cardiology.

The randomized, placebo-controlled Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist trial (TOPCAT; Clinicaltrials.gov Identifier: NCT00094302) sought to examine the effect of spironolactone, an aldosterone antagonist, in patients with HFpEF. Although, the primary endpoint in this study — a composite of cardiovascular mortality, hospitalization for HF, or aborted cardiac arrest — was not improved in the group receiving spironolactone vs placebo, the MRA was found to be associated with a greater reduction in hospitalizations for HF compared with placebo.

In this retrospective analysis, the discharge prescribing data of patients with left ventricular ejection fraction ≥50% who were in the Get With The Guidelines-HF Registry were examined to assess the impact of lessons from the TOPCAT trial on prescribing patterns in this patient population. The data of 142,201 patients discharged between January 2009 and December 2016 were examined.

A total of 18,581 patients (13.1%) in this cohort were prescribed MRAs at time of hospital discharge. Patients who were vs were not prescribed MRAs at discharge were younger (75 vs 78 years, respectively), were more likely to be white (76.7% vs 72.0%, respectively), to have had a history of HF hospitalizations (75.5% vs 65.7%, respectively), and lower brain natriuretic peptide levels (492 pg/mL vs 545 pg/mL, respectively) at hospital admission.

Prescribing of MRAs was found to increase over time (P <.0001), but not to be affected by results from the TOPCAT study (P =.17).

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A limitation of the study was the sole inclusion of patients within the Get With The Guidelines-HF Registry, which may not be representative of the population of patients hospitalized for HF in the United States.

“There remains an important need for more clinical trials to better establish the efficacy and safety of MRAs for the treatment of HFpEF,” concluded the study authors.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Fudim M, Kelly JP, Brophy TJ, et al. Trends in treatment for patients hospitalized with heart failure with preserved ejection fraction before and after treatment of preserved cardiac function heart failure with an aldosterone antagonist (TOPCAT) [published online March 14, 2020]. Am J Cardiol. doi:10.1016/j.amjcard.2020.02.038